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‘Numerous operations have been described for correction of recurrent dislocation of the patella. The number in itself predicates that the problem has not been solved'. This classic discusses the original publication ‘Diagnosis and treatment of recurrent dislocations of the patella' from Trillat A, Dejour H, Couette A. Published in 1964 at the Revue de Chirurgie Orthopedique et Reparatrice de L'appareil Moteur, where the authors described a surgical procedure modifying Elmslie's original surgery for patients with objective patellar dislocations and also for patients with anterior knee pain who had the sign of the ‘baionnette'. Medialisation of the anterior tibial tubercle (ATT) has been known worldwide as the Elmslie-Trillat procedure, but the history of procedure has its roots going back to 1888. The history of the publications of the Elmslie-Trillat technique is really something special. Cesar Roux published in 1888 the original technique that is similar to Elmislie's procedure. In 1944 in London, Trillat met Selddon and became aware about Elmslie's procedure for the ATT medialisation. Back to France, Trillat published and named it as the Elmslie's technique. Later, after the ‘Journees du Genou', the technique was disseminated as ‘The Elmslie-Trillat' procedure. Nowadays, isolated ATT medialisation, the ‘true' Elmslie-Trillat operation, is still occasionally performed. Too few surgeons use these elegant operations largely because the details of the techniques are not taught routinely. This classic section has the objective to encourage young surgeons to learn tibial tubercle transfer operations and the benefits they bring to patients when performed for proper indications.

Objective Investigate the patellar force-displacement profile (ligament stiffness) of patellofemoral disorders. Methods Fifty-two knees from 34 consecutive patients (mean 31.6 years and 53% male) were analysed including 24 knees with patellofemoral pain (PFP), 19 with potential patellofemoral instability (PPI) and 9 with objective patellofemoral instability (OPI). Physical examination, patient-reported outcome measures (Kujala and Lysholm Scores), standard radiography and MRI or CT were performed in all patients. Instrumented stress testing (Porto Patella testing device) concomitantly with imaging (MRI or CT) was performed to calculate ligament stiffness. Results The force-displacement curves in patients with PPI and OPI displayed a similar pattern, which was different from that of the PFP group. Patients with PPI showed higher ligament stiffness (a higher force was required to displace the patella) than the patients in the OPI group. Patients with OPI had a statistically significant shallower trochlear groove and increased lateral tilt. More than half of the PPI and OPI population presented with at least one classic risk factor (patella alta, trochlear dysplasia, increased quadriceps vector, lateral tilt). In the PPI group, at least two risk factors were found in 37% of patients, whereas at least 33% of patients in the OPI group had three risk factors present. None of the patients presented with all four anatomical risk factors. Conclusion Patients presenting with patellofemoral instability (PPI and OPI) display similar ligament stiffness patterns (force-displacement curve). Patients with PFP and PPI showed higher ligament stiffness as compared with patients with OPI. Level of evidence Level V, case series.

"Article in press" ; "Published online: November 27, 2017", Patellar tendon ruptures can lead to significant functional deficiency of the extensor mechanism of the knee. These injuries, because of their inherent nature and associated complications, may require a complex treatment and remains a challenge for orthopaedic surgeons. Current surgical techniques present significant complications, including patellar fracture, damage to patellar articular cartilage, and abnormal patella height. This note describes a surgical technique to provide an additional reinforcement to the patellar tendon repair with a semitendinous autograft, without the necessity to perform any transosseous tunnels at the patella bone. First, the patellar tendon is repaired with an end-to-end technique and the semitendinous tendon is harvested. A transosseous tunnel at the tibial tubercle is drilled and 2 rents are made, both medial and lateral to the retinaculum at the level of the intermedial segment of the patella close to the patellar margin. The graft is passed through the tunnel and rents in a U-shaped form. The graft is sutured along the length of the patellar tendon on both margins in tension at 30 of knee flexion. Fluoroscopy imaging is performed to assess the patella height. This technique provides a significant augmentation of patellar tendon, avoiding the potential patella bone tunnel complications., info:eu-repo/semantics/publishedVersion

Patellar dislocation is a major orthopaedic concern in pediatric and adult populations, with both conservative and surgical options available. Several surgical techniques of the combined or isolated reconstruction of the medial patellofemoral ligament are described in the literature using different grafts, locations, and types of fixations, providing different advantages and disadvantages. New recent developments in cadaveric dissection studies have unveiled the importance of structures that were neglected until recently, such as the medial quadriceps tendon–femoral ligament, which provides a connection between the medial femur and the quadriceps tendon component of the knee extensor mechanism. Hence, we present a surgical technique with combined reconstruction of the medial patellofemoral ligament and medial quadriceps tendon–femoral ligament without the use of hardware and with no need for patellar or femoral drilling (no physis compromise or risk of patellar fracture), which can be used concomitantly with other bony procedures.

Purpose To identify the normal and injured magnetic resonance imaging appearance of the anterolateral ligament (ALL). Methods A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed and Cochrane Library electronic databases were used to search for studies that reported the imaging outcomes of the appearance of the ALL. Two authors performed the searches in duplicate up to April 30, 2018, and interobserver agreement was calculated. The methodologic quality of included articles was assessed using an adaptation of the Arrive methodologic quality scale for clinical studies of radiologic examinations. Results From the original 270 records, a total of 24 studies (κ = 0.94) comprising 2,427 knees in 2,388 patients (mean age, 33.3 years; 66% male patients; 63% with anterior cruciate ligament [ACL] injury) were included. The ALL appeared in 51% to 100% of all assessed knees (71%-100% in ACL-injured knees and 64%-97% in uninjured knees) and was injured in 11% to 79% of ACL-injured knees. Reliability rates varied considerably (0.04-1.0 for intraobserver and 0.143-1.0 for interobserver agreement), and the entire portion of the ligament was often not seen. The tibial insertion was seen in 21% to 96% of cases, followed by the meniscal (range, 0%-100%) and femoral (range, 0%-90%) insertions. The mean methodologic quality score was 5.1 ± 1.8 out of a possible score of 9. Conclusions High variability was found in the identification of normal and injured ALL definition methods and the respective magnetic resonance imaging findings. Reliability rates varied considerably, and the entire portion of the ligament was often not seen. Level of Evidence Level IV, systematic review of Level II to IV studies.

After proliferative activation of rat liver cells in vivo by a partial hepatectomy a decrease of the calmodulin content in the three plasma membrane domains (blood sinusoidal, canalicular and lateral) was observed. At 24 hours after partial hepatectomy calmodulin was found to be 3 fold lower in the sinusoidal and lateral fractions whereas a 2 fold decrease was detected in the canalicular domain. Decreases on the actin levels have been also detected at 24 hours after a partial hepatectomy. Since at this time after surgery increases on nuclear actin and calmodulin have been reported, these results suggest the possibility that the actin and calmodulin dissociated from the plasma membrane after a partial hepatectomy could subsequently be translocated into the nuclei.

We have identified a protein (p55) with a molecular weight of 55 kDa and a pI of 6.2, which was strongly increased in the nuclear matrix of rat liver cells during proliferative activation. This protein is highly insoluble since it could not be solubilized either by detergents or by alkaline extraction. We have obtained three partial amino acid sequences which revealed that p55 has a high homology with cytokeratins. Polyclonal antibodies raised against p55 were used to carry out Western blot and immunocytochemical studies which indicated that p55 was localized only in the nuclei, specifically in the nuclear matrix. Autoradiographic experiments revealed that not all the cells presenting an increase in p55 incorporated [3H]thymidine, indicating that this protein is not related to DNA replication. Immunocytochemical studies also revealed that during mitosis p55 is localized surrounding the chromosomes and associated with the mitotic apparatus, suggesting that p55 is involved in the separation of chromosomes during cell division.